How do you measure trust in social institutions and health professionals? A systematic review of the literature (2012–2021)

Abstract

The importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID‐19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and need for research to strengthen the validity of measures. Given developments in our understandings of trust since its publication, we sought to identify new scales developed, existing ones adapted in response to identified gaps, and agendas for future research. Using the PRISMA approach for systematic reviews, we conducted a search in four databases. A total of 26 articles were assessed. Twelve new scales were identified, while 14 were adapted for different settings and populations. Literature continues to focus on measuring trust in health professionals rather than systems. Various shortcomings were identified, including some articles not mentioning the dimensions included in the scale and suboptimal use of validity and reliability testing and/or reporting. Moreover, a variety of terms were used for dimensions. Future research is needed to address these gaps and consequently, to understand their correlation with health behaviors and outcomes more accurately.

Development and validation of the Trust in Multidimensional Healthcare Systems Scale (TIMHSS)

“…The conflation of trust with related yet distinct terms is critical to the development and validation of measures, yet this consideration has been overlooked in the creation of many existing measures. For example, despite research identifying semantic distinctions between trust and confidence [ 31 , 36 ], measures continue to include confidence as a dimension of trust [ 11 ]. Further, research has demonstrated a conceptual distinction between trust and dependence, with the authors cautioning researchers who “may think they are measuring ‘trust’ and policy may be aimed at increasing ‘trust’, but unless both of them recognise the interplay between risk, familiarity and time, they may be measuring something other than trust” [ 27 ] (p. 13).…”

“…This may explain why, despite the recognised multidimensionality of the construct, of the 43 measures identified in a 2013 review, 60% were unidimensional [ 39 ]. A more recent systematic review of measures of trust in social institutions, including healthcare, identified benevolence, competence, and equity as the most recurring dimensions, but the category “other” was also one of the most frequent [ 11 ]. The authors argue that the growth of the ‘other’ category is not occurring due to the rise of new dimensions to reflect the evolution of trust but rather, is an inconsistency in taxonomy.…”

“…Central to our work is also the limited number of quantitative studies conducted to investigate trust in doctors, systems, and policy via a single measure [ 11 ]. Further, relative to other levels of analysis, literature on trust in health care organisations is small [ 9 ].…”

“…Twelve new scales were identified, while 14 existing scales were adapted for different settings and populations. Further details of our methods to this review are presented elsewhere [ 11 ]. The review was conducted to identify gaps in existing measures since the publication of the 2012 review of measures of trust in healthcare conducted by Ozawa and Sripad.…”

“…A reliable measure of trust, with demonstrated use in diverse populations, is thus critical for evaluating and informing interventions to improve trust, targeting doctors, health systems, and health policy. However, existing tools used to measure trust in healthcare have limitations in their ability to inform change at the doctor, system, and policy level through a single measure [ 11 ]. This limitation, among others detailed below, was instrumental in the conception of the present research.…”